• Posted April 8, 2025

TB Cases Go Undetected In Prisons, Threatening Nearby Communities

Tuberculosis (TB) might seem like a disease from days gone by, but a new study suggests the COVID pandemic might have given the infectious menace a new foothold.

Most modern-day TB cases happen in prisons, where inmates in close quarters are more likely to pass the disease between them, researchers say.

But during the pandemic, TB diagnoses fell dramatically in prisons -- not because there weren’t new cases, but because officials weren’t detecting them, researchers argue.

Undiagnosed TB in a prison increases the risk of an outbreak in the surrounding community, said co-lead researcher Amy Zheng, a doctoral student at the Boston University School of Public Health.

“When countries are unable to detect tuberculosis in high-risk populations — such as people who are incarcerated — it increases the risk of transmission, both within prisons and to the broader community, when people are released from prison,” Zheng said in a news release.

Tuberculosis re-entered the news last week when a new case of TB was confirmed at Waukegan High School, a suburban high school near Chicago.

Public health officials did not say whether the person is an adult or student, only that they have been isolated from others and are undergoing treatment, according to CBS News.

"TB is a serious disease. It spreads through the air, so we're concerned when people are in close spaces like schools and workplaces," Lake County Health Department Executive Director Chris Hoff told CBS. "And while you may not hear a lot about TB anymore, we still get about 20 cases a year — and so our staff deals with this every day."

Tuberculosis is caused by bacteria that spread through the air when an infected person breathes, coughs or speaks.

Active TB commonly affects the lungs, but can spread to other parts of the body like the spine, brain, liver or kidneys, according to the U.S. Centers for Disease Control and Prevention (CDC). If left untreated, the infection can be fatal.

Previous research has indicated that prisoners are at 10 times greater risk for tuberculosis than the general population, researchers said in background notes.

However, reported TB cases in European and American jails dropped during the pandemic, researchers found.

For the study, researchers analyzed international TB reporting data to track trends among nearly 5 million people a year who were incarcerated in 47 countries in Europe and the Americas from 2010 to 2022. This sample represents about 42% of the world’s incarcerated population.

TB cases fell as much as 100% in Central and North America in 2021 and nearly 87% in Western Europe in 2022, results show.

That happened even though incarceration levels remained largely consistent, researchers said. The infection pattern also was different from tuberculosis diagnoses among the general public, which went down in 2020 but increased in subsequent years.

This likely means that there are many cases of TB among inmates that haven’t been caught, perhaps because prisons didn’t have the capacity to test for the infectious disease during the pandemic, researchers said.

The 10 countries that reported the largest percentage decrease between observed and expected TB diagnoses were Slovakia, Czech Republic, El Salvador, Bulgaria, Belgium, Azerbaijan, Armenia, Romania, Uruguay and Ukraine.

These results come as aid groups scramble to respond to the Trump Administration’s massive funding cuts and dismantling of the U.S. Agency for International Development, which provided substantial funding toward the global TB response, researchers said.

Global efforts to fight TB have saved about 79 million lives since 2000, according to the World Health Organization (WHO).

“Recent federal cuts to USAID funding and programming have already significantly impacted tuberculosis control and will severely harm the progress made to reduce tuberculosis globally over the past few decades,” senior researcher Leonardo Martinez, an assistant professor of epidemiology at Boston University, said in a news release.

“Future studies will be necessary to better understand how these funding cuts may negatively affect tuberculosis control in prisons,” he added.

Worse, this loss in funding threatens to reverse the global goal to end TB by 2030, Martinez said.

“Given the current disruption in funding, achieving the 2030 global goals to end the tuberculosis epidemic may no longer be feasible,” researcher Zheng said. “As a result, the tuberculosis field must come together globally and regionally to set new, realistic targets and identify new, alternative funding mechanisms to reach those targets.”

The new study was published in the April issue of The Lancet Public Health.

More information

The U.S. Centers for Disease Control and Prevention has more about tuberculosis.

SOURCE: Boston University, news release, March 31, 2025